Interaction of chloral hydrate and ethanol in man. II. Hemodynamics and performance

Studies with psychedelic drugs in human volunteers

Scientific curiosity and fascination have played a key role in human research with psychedelics along with the hope that perceptual alterations and heightened insight could benefit well-being and play a role in the treatment of various neuropsychiatric disorders. These motivations need to be tempered by a realistic assessment of the hurdles to be cleared for therapeutic use. Development of a psychedelic drug for treatment of a serious psychiatric disorder presents substantial although not insurmountable challenges. While the varied psychedelic agents described in this chapter share some properties, they have a range of pharmacologic effects that are reflected in the gradation in intensity of hallucinogenic effects from the classical agents to DMT, MDMA, ketamine, dextromethorphan and new drugs with activity in the serotonergic system. The common link seems to be serotonergic effects modulated by NMDA and other neurotransmitter effects. The range of hallucinogens suggest that they are distinct pharmacologic agents and will not be equally safe or effective in therapeutic targets. Newly synthesized specific and selective agents modeled on the legacy agents may be worth considering. Defining therapeutic targets that represent unmet medical need, addressing market and commercial issues, and finding treatment settings to safely test and use such drugs make the human testing of psychedelics not only interesting but also very challenging. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.

The medico-legal significance of pharmacokinetic interactions with ethanol

In the UK, the maximal permitted ethanol concentration for driving is 80 mg ethanol/100 mL blood, 35 μg ethanol/100 mL breath or 107 mg ethanol/100 mL urine. Drivers exceeding the prescribed limit face severe penalties, which they are often anxious to avoid, either by acquittal or by putting forward 'special reasons' why they should not be disqualified from driving. One frequently explored defence is that the accused was taking prescribed medication. Defence solicitors often ask the question whether the prescribed medication could have caused significantly altered blood ethanol concentrations. This paper reviews the impact of various medications and how they can influence the blood ethanol concentration. Although many drugs can interact with ethanol at a pharmacodynamic level, causing increased impairment, relatively few drugs interact with ethanol pharmacokinetically leading to significantly altered blood ethanol concentrations.

Cardaic arrhythmias in chloral hydrate poisoning

In three patients admitted to hospital after ingestion of an overdose of chloral hydrate, the ECG showed supreventricular and ventricular tachyarrhythmias. The possible mechanism for the arrhythmias may be an enhanced automaticity of supraventricular and ventricular pacemaker cells caused by metabolites of chloral hydrate. The ventricular arrhythmia responded to i.v. treatment with lignocaine in one patient, and to phenytoin in another in whom lignocaine failed to restore a normal sinus rhythm.

Quantified EEG analysis monitoring in a novel model of general anaesthesia in rats

The aim of this research was to evaluate the safety and reliability of an anaesthetic mixture (Equitensine: pentobarbital, chloral hydrate, dihydroxypropane, ethanol) which, unlike other 'classic' anaesthetics, such as ketamine [The Electroencephalogram in Anaesthesia, Springer, Berlin, 1984], has been demonstrated not to induce alterations in the extracellular concentrations of cerebral excitatory amino acids. Quantified EEG analysis monitoring and behavioural observation were used to quantify the degree and the time course of the changes in cerebral electrical activity, analgesia and sedation induced, in rats, by the compound under investigation. Equitensine (0.33 ml/100 g), administered intraperitoneally, induced analgesia (monitored by the tail flick method) for 60-70 min and a pattern of behavioural sedation (loss of the righting reflex) lasting, on average, 130-150 min. The EEG monitoring revealed a pattern typical of burst suppression which lasted 15-20 min, followed by another, lasting 270-300 min, characterized by slow waves of high amplitude. The quantified EEG analysis demonstrated that the changes in cerebral electrical activity lasted longer than behavioural observation suggested. The compound under examination was found to be safe, reliable and non-invasive to administer and sustain in all the animals, and quantified EEG analysis proved to be a very sensitive method for highlighting the functional changes in the central nervous system.

Biochemical and pharmacological characterization of 1-trichloromethyl-1,2,3,4-tetrahydro-beta-carboline: a biologically relevant neurotoxin?

Acute and long-term effects of exposure to reactive compounds as the result of environmental pollution, workplace conditions or dietary intake are suspected to be involved in the etiology of a variety of disorders, including neurodegenerative disorders such as Parkinson's disease. The recognition in 1970s that 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), a neurotoxic by-product of illicit meperidine synthesis, elicits parkinsonian symptoms in primates, including man, prompted the search for naturally occurring analogs which might be involved in human disease. It has been suggested that one candidate, 1-trichloromethyl-1,2,3,4-tetrahydro-beta-carboline (TaClo), a potent dopaminergic neurotoxin, might be formed endogenously in humans following the administration of the hypnotic chloral hydrate or after the exposure to the industrial solvent trichloroethylene. Such spontaneous formation has, indeed, been recently reported. The biochemical and pharmacological characteristics of TaClo and related compounds are thus reviewed here, and their potential significance for human neurodegenerative disease discussed.

Consideration of the target organ toxicity of trichloroethylene in terms of metabolite toxicity and pharmacokinetics

Trichloroethylene (TRI) is readily absorbed into the body through the lungs and gastrointestinal mucosa. Exposure to TRI can occur from contamination of air, water, and food; and this contamination may be sufficient to produce adverse effects in the exposed populations. Elimination of TRI involves two major processes: pulmonary excretion of unchanged TRI and relatively rapid hepatic biotransformation to urinary metabolites. The principal site of metabolism of TRI is the liver, but the lung and possibly other tissues also metabolize TRI, and dichlorovinyl-cysteine (DCVC) is formed in the kidney. Humans appear to metabolize TRI extensively. Both rats and mice also have a considerable capacity to metabolize TRI, and the maximal capacities of the rat versus the mouse appear to be more closely related to relative body surface areas than to body weights. Metabolism is almost linearly related to dose at lower doses, becoming dose dependent at higher doses, and is probably best described overall by Michaelis-Menten kinetics. Major end metabolites are trichloroethanol (TCE), trichloroethanol-glucuronide, and trichloroacetic acid (TCA). Metabolism also produces several possibly reactive intermediate metabolites, including chloral, TRI-epoxide, dichlorovinyl-cysteine (DCVC), dichloroacetyl chloride, dichloroacetic acid (DCA), and chloroform, which is further metabolized to phosgene that may covalently bind extensively to cellular lipids and proteins, and, to a much lesser degree, to DNA. The toxicities associated with TRI exposure are considered to reside in its reactive metabolites. The mutagenic and carcinogenic potential of TRI is also generally thought to be due to reactive intermediate biotransformation products rather than the parent molecule itself, although the biological mechanisms by which specific TRI metabolites exert their toxic activity observed in experimental animals and, in some cases, humans are not known. The binding intensity of TRI metabolites is greater in the liver than in the kidney. Comparative studies of biotransformation of TRI in rats and mice failed to detect any major species or strain differences in metabolism. Quantitative differences in metabolism across species probably result from differences in metabolic rate and enterohepatic recirculation of metabolites. Aging rats have less capacity for microsomal metabolism, as reflected by covalent binding of TRI, than either adult or young rats. This is likely to be the same in other species, including humans. The experimental evidence is consistent with the metabolic pathways for TRI being qualitatively similar in mice, rats, and humans. The formation of the major metabolites--TCE, TCE-glucuronide, and TCA--may be explained by the production of chloral as an intermediate after the initial oxidation of TRI to TRI-epoxide.(ABSTRACT TRUNCATED AT 400 WORDS)

Concurrent and simultaneous use of alcohol with sedatives and with tranquilizers: results of a national survey

The purpose of the present study was to determine the prevalence of concurrent and simultaneous use of alcohol with sedatives and with tranquilizers in the general population and to examine differences in these rates between important sociodemographic subgroups. The results indicated that a sizable proportion of Americans engaged in both substance use practices in the year preceding the interview. The population estimate for simultaneous use of alcohol in combination with sedatives (i.e., use of both substances simultaneously or on the same occasion) was approximately 3 million while the concurrent use of both substances (i.e., during the same time period) was approximately 4 million. Corresponding figures for the simultaneous and concurrent use of alcohol and tranquilizers were both approximately 6 million. The extent of each substance use practice varied as a function of sociodemographic factors. Implications of these findings are discussed in terms of the need for age-sex-ethnic-specific prevention strategies. The need for future analytic epidemiological research to determine the precise relationship between dose, frequency, and duration of concurrent and simultaneous use and each adverse consequence is emphasized. The need for longitudinal research in the general population is also highlighted.

Psychophysiological effects of oral ethanol in alcoholics and social drinkers

The acute and extended effects of ethanol ingestion were examined in five alcoholic subjects, and five "social" drinkers. Six physiological and four subjective report measures were taken before, during and up to 90 min after the ingestion of ethanol in three doses and placebo. Findings showed that alcohol exerted significant dose-related physiological effects in the initial minutes of ingestion, and in extended analyses of physiological and subjective measures in both groups of drinkers. Alcoholics and social drinkers generally did not differ in their physiological responses to alcohol doses and placebo, while some evidence for tolerance to reported euphoric effects of alcohol in the alcoholic subjects was found. The possibility is raised that early physiological responses observed during ethanol ingestion may arise not only from pharmacological effects of the drink, but may also be evidence for conditional predrink responses.

Diazepam actions and plasma concentrations following ethanol ingestion

In eight normal volunteers, the combination of ethanol (0.5 g/kg) and diazepam (10 mg) administered orally produced a greater decrease in motor performance on a pursuit rotor than diazepam alone. The pharmacologic effect of diazepam was enhanced by 73% and this potentiation was associated with significantly greater diazepam concentrations (p less than 0.01) than after diazepam alone. The failure to observe any increase in the concentrations of the principal metabolite, N-desmethyl diazepam, during the period of enhanced pharmacologic effect precludes any change in the demethylating metabolic process as being responsible. The data suggest (0.10 greater than p greater than 0.05) a trend to a smaller volume of distribution of diazepam when ethanol is administered prior to diazepam ingestion. The subjects showed acute tolerance to the effects of diazepam. Lower plasma concentrations on the ascending side of the plasma diazepam concentration versus time profile were linked with the same pharmacologic responses associated with a greater drug concentration on the descending portion, of the same curve.

Interactions of CNS drugs--hypnotics and sedatives

The physicochemical properties of the barbiturates and a brief review of microsomal enzyme induction introduces this literature review of the interactions of sedative and hypnotic drugs. Food has been shown to delay absorption of barbiturates; barbiturates, in turn, may interfere with the absorption of griseofulvin, dicumarol, and folic acid. Barbiturate-produced enzyme induction may result in interactions with the oral anticoagulants, the anticonvulsants, vitamin D, bilirubin, digitoxin, doxycycline, and perhaps other drugs. The problem of additive central nervous system depression and the relative lack of documented evidence is considered. Finally, the interactions of nonbarbiturate hypnotics, such as glutethimide, chloral hydrate, and others are reviewed.

Metabolism of trichloroethylene in man. III. Interaction of trichloroethylene and ethanol

Volunteers inhaled a constant concentration of 50 ppm trichloroethylene (Tri) for 6 hrs per day on 5 consecutive days. Simultaneous ethanol (EtOH) ingestion (blood level 0.6%) inhibits the metabolization of Tri to trichloroethanol (TCE) and trichloroacetic acid (TCA) by 40% on the average. Oxidation of Tri to TCA does not occur as long as EtOH is present. During this time period the blood Tri-concentration increases 2 1/2-fold, that in the expired air rising 4-fold, as compared to Tri inhalation without EtOH. TCE glucuronidation is not subject to inhibition. On concurrent inhalation of Tri, the EtOH and acetaldehyde levels are slightly increased over the control values without Tri. The mechanisms underlying the alternate inhibition of mixed-function oxygenases and aldehyde dehydrogenase on simultaneous intake of Tri and EtOH are discussed. The intolerance reaction occurring on combined exposure to Tri and EtOH can be interpreted as an accumulation of Tri in the CNS resulting from the complete depression of Tri oxidation.